Individual
JENNIFER ANN BLASER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4401 N MAIN ST, ROCKFORD, IL 61103-1277
(779) 771-6866
Mailing address
W7518 MELVIN RD, BROWNTOWN, WI 53522-9709
(608) 214-6548
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160006093
IL
Other
Enumeration date
08/04/2015
Last updated
08/04/2015
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